Method and apparatus involving intercostal and lumbar perfusion

Abstract

A method and apparatus for providing circulation to distal organs and blood flow for intercostal lumbar perfusion during aortic surgery by means of an intercostal and lumbar perfusion shunt having a main tubular member defining a first flow path and a plurality of side tubular members connected intermediate the ends of the main tubular member and defining a plurality of second flow paths. The method includes the steps of shunting a pathologic section by connecting the free ends of the main tubular member to the aorta proximal and distal to the pathology for providing blood flow to the distal organs and by connecting the free ends of the side tubular members to the intercostals through an opening in the aorta for providing blood flow to the intercostals during surgery.

What is claimed is: 
     
       1. An intercostal lumbar perfusion apparatus for providing circulation to distal organs and blood flow to the intercostals during aortic surgery, said apparatus comprising: (a) a main member defining a first flow path, said main member including first and second ends, said first end configured to be connected proximal to a pathological section in the aorta and said second end configured to be connected distal to a pathological section in the aorta, said main member providing adequate circulation of blood distal to the pathological section during aortic surgery when said first and second ends are connected to the aorta;   (b) a plurality of side members defining a second flow path for providing blood flow for intercostal lumbar perfusion, said side members connected to said main member intermediate said first and second ends thereof, said second flow path communicating with said first flow path, said side members are sized and shaped to be inserted into and snugly fit within the intercostals with minimum resistance to be able to provide adequate blood flow to distal organs; and   (c) a plurality of clip means operatively connected to said side members, each said clip means including a head and a pair of opposed depending legs, each said depending leg having hooked gripping means for holding said side member in place when said side members are inserted into the intercostals.   
     
     
       2. The intercostal lumbar perfusion apparatus as claimed in claim 1 wherein said depending legs are biased apart, hook means provided at a distal end of each said depending leg, said hook means configured to piece an artery wall when said side members are inserted into the intercostals and said depending legs are squeezed together. 
     
     
       3. The intercostal lumbar perfusion apparatus as claimed in claim 2 including connector means disposed in said first flow path, said connector means having means for permitting a portion of the blood flowing in said first flow path to flow into said second flow path. 
     
     
       4. The intercostal lumbar perfusion apparatus as claimed in claim 3 wherein said connector means includes first Y-connector means having first, second and third leg means, said first and second leg means connected to said main member intermediate the ends thereof, said first and second leg means disposed in said first flow path, said third leg means operatively connected to said side members, said third leg means disposed in said second flow path. 
     
     
       5. The intercostal lumbar perfusion apparatus as claimed in claim 4 wherein said connector means includes second Y-connector means having first, second and third branch means, said first branch means connected to said third leg means, said second and third branch means connected to said side members, said third leg means and said first, second and third branch means disposed in said second flow path. 
     
     
       6. The intercostal lumbar perfusion apparatus as claimed in claim 5 wherein said main member and said side members are tubular members, the diameter of said main member is larger than the diameter of said side members, said side members having narrowed tips that are configured to snugly fit into selected intercostals. 
     
     
       7. The intercostal lumbar perfusion apparatus as claimed in claim 2 including connector means having interconnected first, second and third legs, said first, second and third legs communicating with one another to permit fluid flow therebetween, said first and second legs connected to said main member, said third leg connected to said side members, said first and second legs lying in said first flow path, said third leg lying in said second flow path. 
     
     
       8. The intercostal lumbar perfusion apparatus as claimed in claim 7 wherein main member and said side members are tubular members, the diameter of said side tubular members being smaller than the diameter of said main tubular member, said side members having narrowed tips of selected sizes that are configured to snugly fit into selected intercostals. 
     
     
       9. The intercostal lumbar perfusion apparatus as claimed in claim 2 including locking means for holding said depending legs in their squeezed position. 
     
     
       10. A method for performing aortic surgery and providing circulation to distal organs and intercostal blood flow for intercostal lumbar perfusion during aortic surgery using an intercostal lumbar perfusion apparatus having a main member defining a first flow path and a plurality of intercostal connecting side members defining a second flow path, the side members connected to the main member intermediate the ends thereof, the side members having tips that are selected to interconnect with the intercostals, clips provided on the side members, said method comprising the steps of: (a) connecting the ends of the main member to the aorta proximal and distal to a pathologic section in the aorta and shunting the pathology;   (b) deairing the main member and the side members, and clamping the side members with first clamping means;   (c) attaching proximal clamping means and distal clamping means to the aorta between the pathologic section and the ends of the main member, said proximal and distal clamping means are positioned adjacent the pathological section so as to include only a minimum number of intercostals between said proximal and distal clamping means;   (d) longitudinally cutting the pathological section of the aorta between said proximal and distal clamping means to expose the intercostal orifices;   (e) connecting the tips of the deaired ends of the side members to exposed intercostals and fixing them in place with the clips provided on the side members, removing the first clamping means to permit blood flow through the side members to the intercostals;   (f) attaching one end of a graft to one of the proximal and distal ends of a healthy section of the cut aorta;   (g) cutting the aorta about the perfused intercostals;   (h) removing a section of the graft which corresponds to the cut aorta containing the perfused intercostals;   (i) attaching the section of the aorta containing the perfused intercostals to the graft in place of the removed section of the graft and leaving a loosely stitched area about the side members;   (j) clamping the graft between its opened end and the loosely stitched section beyond its attached end;   (k) clamping and removing the side members through the loose stitches and tightening the loose stitching about the graft area, removing the clamping means at the end of the aorta to which the graft has been attached;   (l) attaching the other end of the graft to the other of the proximal and distal ends of the cut aorta so as to form a complete aorta;   (m) removing any remaining clamping means on the aorta and graft and deairing the graft; and   (n) removing the main body and closing the opening through which the main body was inserted into the aorta.   
     
     
       11. A method of performing aortic surgery and providing circulation to distal organs and blood flow for intercostal lumbar perfusion during aortic surgery using an intercostal lumbar perfusion apparatus having a main member defining a first flow path and plurality of said members with narrowed tips defining a second flow path, said side members connected to the main member, said method comprising the steps of: (a) a connecting the main member to the aorta to provide blood flow to organs distal to a pathologic section in the aorta;   (b) deairing and clamping the side members;   (c) clamping the aorta above and below the pathologic section;   (d) cutting the aorta and exposing intercostals in the pathologic section;   (e) rapidly connecting the free ends of the deaired side member tips to the intercostals;   (f) unclamping the side members and permitting blood to flow into the intercostals;   (g) attaching one end of a graft to the cut aorta;   (h) removing a section of the graft that corresponds to the cut section of the aorta which contains the intercostals; and   (i) attaching the section of the aorta containing the intercostals to the graft in place of the removed section of the graft.   
     
     
       12. An intercostal lumbar perfusion apparatus for use with a cardiopulmonary bypass machine or a left atrial to femoral bypass machine for providing circulation to distal organs and blood flow to the intercostals during aortic surgery, the apparatus comprising: (a) a main member configured to be interconnected with an arterial inflow line of a cardiopulmonary bypass machine or the femoral line to the left atrial to femoral bypass machine, said main member defining a first flow path through which blood flows from the cardiopulmonary bypass machine or left atrial to femoral bypass machine for providing circulation to organs distal of a pathologic section of the aorta;   (b) at least one side member connected to said main member and configured to connect with the intercostals, said side member defining a second flow path for providing blood flow for intercostal lumbar perfusion, each said side member sized and shaped to be connected to an intercostal, said second flow path communicating with said first flow path, a quantity of blood flowing in said first flow path and through said main member flowing into said second flow path and through said side member;   (c) a plurality of clip means operatively connected to said side members, each said clip means including a head and a pair of opposed depending legs that are biased away from each other, each said depending leg having hooked gripping means for holding said side members in the intercostal artery, said clip means configured to hold said side members in the intercostal artery; and   (d) connector means disposed in said first and second flow paths, said connector means having means for directing blood flowing in said first flow path into said second flow path.   
     
     
       13. The intercostal lumbar perfusion apparatus as claimed in claim 12 including a plurality of intercostal connecting side members having tips, each said tip being sized and shaped to interconnect with a selected one of the intercostals. 
     
     
       14. The intercostal lumbar perfusion apparatus as claimed in claim 13 wherein said intercostal connecting side members include a plurality of cannulae that are sized to fit into selected intercostals. 
     
     
       15. The intercostal lumbar perfusion apparatus as claimed in claim 14 wherein said tips have a diameter that is in the range of 1.5 mm to 5.0 mm. 
     
     
       16. The intercostal lumbar perfusion apparatus as claimed in claim 13 wherein said intercostal connecting side members include a plurality of cannulae and a plurality of tipped catheters having narrowed and thin walled tips that are sized to fit into selected intercostals. 
     
     
       17. The intercostal lumbar perfusion apparatus as claimed in claim 16 wherein said tips have a diameter that is in the range of 1.5 mm to 5.0 mm. 
     
     
       18. A method for performing aortic surgery and providing circulation to distal organs and blood flow for intercostal lumbar perfusion during aortic surgery using an intercostal lumbar perfusion apparatus having a main member defining a first flow path and plurality of side members with narrowed tips defining a second flow path, said side members connected to the main member, said method comprising the steps of: (a) connecting the main member to the aorta to provide blood flow to organs distal to a pathologic section in the aorta;   (b) deairing and clamping the side members;   (c) clamping the aorta above and below the pathologic section by attaching clamping means to the aorta between the pathologic section and the two ends of the main member;   (d) cutting open the aorta and exposing the excluded intercostals;   (e) rapidly connecting the free ends of the deaired side member tips to the exposed intercostals;   (f) unclamping the side members and permitting blood to flow into the intercostals;   (g) attaching one end of a graft to the cut aorta;   (h) removing a section of the graft that corresponds to the cut section of the aorta which contains the intercostals; and   (i) attaching the section of the aorta containing the intercostals to the graft in place of the removed section of the graft and leaving a loosely stitched area about the side members, and then finishing the anastomosis and advancing the aortic clamp so that blood flow to the intercostals is switched from the side members to the main member, whereby blood flow is not interrupted.